Hormonal contraceptives thromboembolism

ACHES—for women taking hormonal contraceptives A = Abdominal pain. This may be an early warning sign of the presence of an abdominal thromboembolism, liver adenoma, or gallbladder disease. 

S = Severe leg pain. Patients taking hormonal contraceptives who complain of severe leg pain should be evaluated for the presence of venous thromboembolism. 

Gomes MPV, Deitcher SR Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy A clinical review. Arch Intern Med 2004 164 1965. [PMID 15477430]... 

World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Effect of different progestagens in low oestrogen oral contraceptives on venous thromboembolic disease. Lancet 1995 346(8990) 1582-8. 

One of the risks associated with use of combined hormonal contraceptives is venous thromboembolism, but in women without other contributing risk factors the risk of thrombosis is less than that observed during pregnancy. The risk of thromboembolism increases with both age and the presence of other risk factors, such as obesity or an immobilizing illness. There is also a small risk of arterial disease, particularly if the woman has a previous history of arterial disease, hypertension, diabetes mellitus or if she is obese. 

Cardiovascular The thromboembolic complications of hormonal contraception have been recognized for many years, but unusual forms continue to be reported [16 ]. 

One might add that this is by no means the first pointer to an interaction of hormonal contraceptives with anticoagulants [SEDA-5, 371]. Oral contraceptives have effects on clotting factors and the thromboembolic complications associated with contraceptives are of course very well known. 

Sidney S, Cheetham TC, Connell FA, Ouellet-Hellstrom R, Graham DJ, Davis D, et al. Recent combined hormonal contraceptives (CHCs) and the risk of thromboembolism and other cardiovascular events in new users. Contraception 2013 87(1) 93-100. 

Raymond EG, Burke AE, Espey E. Combined hormonal contraceptives and venous thromboembolism putting the risks into perspective. Obstet Gynecol 2012 119(5) 1039-44. 

Plu-Bureau G, Maitrot-Mantelet L, Hugon-Rodin J, Canonico M. Hormonal contraceptives and venous thromboembolism an epidemiological update. Best Pract Res Qin Endocrinol Metab 2013 27(l) 25-34. 

Rosa MI, Madeira K, Medeiros LR. Can a meta-analysis that included articles with high heterogeneity appropriately evaluate the risk of venous thromboembolism in users of combined hormonal contraceptives containing drospirenone or desogestrel Eur J Contracept Reprod Health Care 2013 18(2) 137-9. 

Much of the evidence on the occurrence of thromboembolic complications with oral contraceptives or hormone replacement therapy has been gathered from European or American populations, and it can be helpful to identify data from other parts of the world, where factors such as... 

Wu O, Robertson L, Langhorne P, et al. Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism a systematic review. The Thrombosis Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study. Thromb Haemost. 2005 94 17-25. 

Oral contraceptives containing oestrogen and postmenopausal hormone replacement therapy predispose to thromboembolism (see p. 724). 

Douketis JD, Ginsberg JS, Holbrook A, et al. A reevaluation of risk for venous thromboembolism with use of oral contraception and hormone replacement. Arch Intern Med 1997 157 1522-1530. 

Modern oral contraceptives can contribute to the incidence and severity of certain diseases if other risk factors are present. The following conditions are considered absolute contraindications for combination oral contraceptives the presence or history of thromboembolic disease, cerebrovascular disease, myocardial infarction, coronary artery disease, or congenital hyperlipidemia known or suspected carcinoma of the breast, carcinoma of the female reproductive tract, or other hormone-dependent/responsive neoplasias abnormal undiagnosed vaginal bleeding known or suspected pregnancy and past or present liver tumors or impaired liver function. The risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who smoke heavily (e.g., >15 cigarettes/day) even low-dose oral contraceptives are contraindicated in such patients. 

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